Transcript m5zn_86ae7aa72a0697a

Infections with Rash
By
Prof. Samir Zamzam
Ped. Department
Zagazig University
Rash may be macule, papule, vesicle, pustule, crust. and
hemorrhagic rash.
Meningitis
Means inflammation the brain meninges
Dura, Archanoid and pia from outside to inside.
Causative organisms:
Neonatal periode and early infancy:
• Group B streptococci
• Gram –ve enteric bacilli (E. coli)
• Lepospirosis
• H. influana type B
Later infancy and childhood:
• H. influenza type B.
• Pneumococci
• Meningiococci
• Staphilococci
• Rarely any other organisms.
Meningiococcal Meningitis
Gram –ve cocci (Neisseria meningitides) A
commensal in the nasophynx of healthy individual.
• Meningiacoccemia occur when the organism
invade the blood stream and disseminate to
various parts of the body.
Pathogenesis:
 The cell wall of the organism contains a lipopolysaccharide (endotoxin) responsible for serious
systemic manifestations.
 This endotoxin leads to systemic toxemia,
prepheral circulatory failure, DIC, bleeding in the
adrenals leads to shock (waterhouse-Fredrichsensyndrome).
 Mode of infection  droplet infection as the
primary focus of infection is in the nasopharynx.
Clinical features:
 Incubation periode  2-10 days.
 Upper resp. tract infection with or without
bacteremia  a self limited common cold like
illness.
 Acute meningio-coccemia  manifest by fever,
malaise, headache and GIT upset. Followed by
rash  peticheal or purpuric (The hallmark of the
disease).
 Hypotension, oliguria with progressive renal
failure and coma.
 Meningiococcal meningitis due to haematogenous
spread to meninges  progressive drowsiness,
vomiting, neck stiffness and convulsions, Kerng's
and prudazinski signs +ve.
Diagnosis:
 Clinical manifestions.
 Culture from the nasopharynx  Isolation of the
meningiocicco.
 Blood culture.
 L.P and CSF examination, cells, protein, glucose,
CSF culture.
Site of L.P  space between (L3-L4 and L4-L5).
Must be done in left lateral position.
Contraindication of L.P:
 Skin infection at the site,
 Bleeding tendency verteberal column deformities.
Treatment:
 The drug of choice is penicillin 250,000 unite
1kg/day in 6 devided doses.
 Ampicillin 300 mg/kg/day.
 Cefotoxime 200 mg/kg/day.
 Chloramphenical 100 mg/kg/day.
Prevention  vaccination for children after 2
years of age immune response lasts for about 2
years.
Chrokenpox (Varicella)
A highly communicable disease.
Infection is through direct or indirect contact.
It is a self limited infection in children except in
immunompromised children  may be fatal.
 The causative agent  DNA virus of the herpes
groups (Varicella zoster virus)  may remain
latent to cause herpes zoster in later life.
Clinical futures:
 Incubation periode  15 days.
 Prodromal stage  malaise, low grade fever,
headache.
 Sometimes the onset may be sudden with the
appearance of rash.  the first sign in majority of
cases.
 The rash pass through all stages macule, papule,
vesicles, pustule crust. all stages are present in the
sametime  pleomorphic  centripetal rash 
moving towards the center.
Itching is mild at first but may become severe in
the pustular stage.
 Hemorrhagic, neonatal chicken pox may occur
when the mother develops chickenpox 5 days
before and 5 days after delivery.
Diagnosis:
 Clinical manifestations.
 CBC  WBCs may be normal, low or increased.
Treatment:
 Symptomatic treatment.
 A cyclovir effective when given early.
 Avoid
aspirin
as
antipyretic
to
prevent
development of Reye's syndrome.
 Itching treated by antihistamines oral or local
applications
paramanganate.

Calamine,
potassium
Complications:
Skin infection, purpura fulminans due to DIC,
ITP.
Bronchopneumonia,
hepatitis, appendicitis.
Prevention:
Vaccination
Encephalitis
myocarditis,
Measles (Rubeola)
 The most common and the most infectious of viral
infection of childhood.
 Characterised by catarrhal symptoms followed by
a typical rash the so called measly rash.
 Meales is unusual before 3 to 4 months of age and
mild in the next 6 months  Because of protection
by the maternal antibodies.
 One attack confers nearly life long immunity.
 Transmission by direct or indirect contact and
droplet infection.
Clinical manifestations:
Prodromal stage  3-5 days characterized by
upper respiratory tract infection, conjunctivitis –
cervical lymphadenopathy, fever – Koplik;s spots
on the buccal mucosa.
Eruptive phase  3 to 5 days after the onset with
the appearance of rash fever tends to regress.
 Face and areas behind ears are the sites of the first
appearance of rash  the rash disappear in the
order of appearance.
 Its lasts for 4-7 days.
Convalescent phase is marked by disappearance of
fever and other constitutial symptoms and rash.
Browny pigmentation and pealing of the skin
appear.
Diagnosis:
 Roseola infnatum (fifth disease)
 Rubella (Jerman measles)
 Infectious mononucleosis (glandular fever).
 Meningiococcemia.
Treatment:
Symptomatic
Complications:
Otitis media, chest infection (Bronchopneumonia),
Keratitis, Activation of T.B, Malnutrition,
encephalitis.
Prevention  vaccination at 9 months of age
Revacination at 15 months
German measles (Rubella)
- Mild infection
- Incubation periode 2 to 3 weeks.
- Propdramal stage lasts for few day (one to 2 days).
 Rash may be the first visible sign.
 It is a macule which spreads from the face to
trunk.
 The rash disappears by the third day.
 Congenital Rubella syndrome
German measles (Rubella)
Transmission of infection from the mother to the
fetous especially during the frist the trimester.

Its
important
manifestations
retardation,
mental
Hepatosplenmegaly,
hepatitis,
media,
pancreatitis,
cleft
are
growth
retardation,
deafness,
palate,
otitis
spinatifida,
microphtholmia cataracts, retinal lesions.
Prevention – vaccination
 MMR at 15 months revaccination at 10-12 years in
females.
Other Pediatric Infections
Mumps (Epidemic Parotitis)
 Infectious viral disease charact by painful swelling
of salivary glands especially parotids.
Clinical manifestations:
Prodnormal stage:
Is short 1-2 days  fever, malaise, sore throot,
carachic and pain behind the ear on showing and
swallowing.
 Tender opedemaious swelling of the parotid
(unilateral or bilateral).
 Tenderness disappear 1-3 days.
 Swelling disappear after 7-10 days.
 Infection leave life long immunity.
D.Diagnosis
 Suppurative parotitis.
 Recurrent parotitis  secondary to allergy or
calculus in the stensen;s duct.
 Paroatitis from HIV, carsacke A, cytomegalovirus.
Diagnosis:
- Clinical, picture.
- C.B.C  leucopenia and lymphocytosis.
- Treatment of Symptomatic
- Prevention vaccination MMR
Complications:
 Orchitis, epididmitis
 Pancreatitis
 Meningeoencephalitis
 Myocarditis,
nephritis,
hepatitis
arthritis,
deafness.
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Poliomeylitis
Acute viral infection characterized by clinical
manifestations varing from nil to rapid paralysis
and even death.
The disease occurs exclusively in humans.
Worldwide prevalence.
The majority of paralytic cases occurs below the
age of 3 years.
Clinical manifestations.
The incubation periode 7-14 days.
The clinical presentations are:
Asymptomatic (silent)
Abortive  viraemia but Not involving CNS
Poliomeylitis
 Non paralytic  encephalic presentation
 Paralytic
- Spinal
- Bulbar
- Bulbospinal
- Encephalitic
Paralysis usually involve large muscles and
asymmetrical.
 Most deaths in poliomyelitis is form respiratory
failure due to involvement of the vital centers.
D. Diagnosis:
 Guillian burre syndrome.
 Transverse myeloitis
 CNS infections (meningitis, encephalitis).
 Botulism.
 Septic arthritis.
 Sever hypokalamia.
Treatment:
 Hospitalization.
 Strect bed rest.
 Minimal handing of the affected parts.
 Analgesics and mild sedation.
 Physiotherapy,
Prevention:
Vaccinations
(Sabin) OPV live attenuated vaccine
(Salk) Parenteral poliovaccine  killed vaccine
pulse
immunization
poliovirus.
in
order
to
eradicate
Petrussis (Whooping cough)
 Pertussis is a highly communicable bacterial
infection.
 Causative organism is a nonmotile, rod-shaped
gram-negative bacillus (Bordetella pertussis).
 Transmission by droplet infection and occasionally
by contact with contaminated objects.
 Incubation periode one to 3 weeks.
 Clinical manifestations:
Catarrhal stage  onset insidious  Rhibitis,
sneezing, lacriomotion, irritating cough which
nocturnal.
Paroxysmal (Spasmodic stage):
Cough comes in paroxysms and is accompanied by
vomiting.
Series of cough in expiration  followed by a sudden
deep violent inspiration with characteristic sound 
whoop. due to laryngeospasm.
 Patient appear suffocated with congested (Red face).
 Paroxysm may be triggered by eating yowing,
sneezing, drinking and any other sudden movement.
Convalescent stage: disturbing cough and vomiting stop.
Diagnosis:
 Clinical manifestations.
 WBCs initially low the increase to 20.000 to 50.000
with abslute lymphocytosis as high as 90%.
 ESR is low.
 Triade of whoop, lymphocytosis and low ESR is
diagnostic
treatment
general
measures,
erythromycin 50 mg/kg/day  2 weeks, prevention
DPT vaccination.